I want to be a ____, should I do HPSP?

I get a lot of questions about specialty choice and the Health Professions Scholarship Program (HPSP). For those unfamiliar with HPSP, it is a program in which the military pays for medical school. In return, you owe the military a certain number of years of service after graduation. For more information on HPSP and how it works, see this article.

For those new to the blog, I received an Air Force HPSP scholarship and I don’t in any way feel that I got a raw deal. I am in a civilian residency right now in my specialty of choice. Ask me again at the end of my active duty service commitment 🙂 That being said, I had a lot of colleagues that felt that they signed up for HPSP without really knowing what they were agreeing to, and part of the purpose of this site is to help people understand what HPSP really is, so they don’t feel later like they were misled.

Now to the question at hand: if you want to go into internal medicine, or ENT, or plastic surgery, should that impact your decision about whether to apply for HPSP? The first thing to consider is that you may change your mind about what specialty you want. I think at least 90% of my classmates changed their mind about their specialty plans at least once. There is nothing wrong with that! It’s healthy and normal to change your specialty plans as you learn more about the different specialty choices.

Why is that so important? Well, because your specialty plans do actually affect whether HPSP is a good deal for you. Let’s look at a few examples. Assume that everyone graduates from medical school with $200k in debt.

Meet Bob

Bob is has no prior military service. He receives a 4-year HPSP scholarship. He has no medical school debt on graduation, and he enters an internal medicine residency in the Air Force. Here is his income, by year, assuming that Congress doesn’t raise military pay at all and that he doesn’t get promoted (which would, admittedly, be weird).

PGY-1: $51,800 plus BAH ($1,800-2,400/month)

PGY-2: $51,800 plus BAH ($1,800-2,400/month)

PGY-3: $58,152 plus BAH ($1,800-2,400/month)

Payback 1: $81,238 plus BAH ($1,800-2,400/month)

Payback 2: $86,492 plus BAH($1,800-2,400/month)

Payback 3: $93, 492 plus BAH($1,800-2,400/month)

Payback 4: $96, 528 plus BAH($1,800-2,400/month)

TOTAL: $670,702-721,102

Now let’s assume that Bob doesn’t do HPSP. He takes $200k in student loans for med school, and does a civilian residency. Exact numbers are harder to find for civilians, so there are a bit more “round”

PGY-1: $50,000

PGY-2: $52,000

PGY-3: $54,000

Attending 1: $185,000*

Attending 2: $186,000*

Attending 3: $187,000*

Attending 4: $188,000*

TOTAL: $902,000

In other words, Bob made about $200k more over 7 years as a civilian, but he had $200k in loans at 7%, so he actually comes out ahead by doing HPSP, but not by as big of a margin as you might think. I’m also not getting into the tax advantages of military pay here because, honestly, the numbers aren’t huge. If he gets out after these 7 years, under the current retirement system he will get nothing for retirement. He might get some sort of VA disability, which would add to these numbers.

What about the non-financial considerations? Well, if Bob wants to do IM, odds are excellent that he will match in a military residency. He is unlikely to be pushed into doing a flight medicine tour if he doesn’t want to.

Let’s say that Bob wanted to go into ENT instead.

The military pay numbers are essentially the same, just with an extra year in residency. Total compensation over 8 years: about $750k. Yes, the numbers are getting rounder. Trust me, $10k here or there is chump change in this discussion.

The civilian residency numbers are also about the same, but with a 4th year. Total residency compensation: about $212k.

Where it’s really different is in the attending years. A new ENT attending makes about $300-330k/year* in the first year out of residency, and that’s pretty stable for the next 4 years. Let’s go with a low-end number and say the ENT makes $300k/year for the first 4 years out of residency, for $1.2 million in 4 years, and $1.4 million over the 8 years.

This means that Bob will make $662k more over the first 8 years after medical school if he doesn’t take the HPSP scholarship. Even after taxes (which take a decent bite out of that $300k/year), Bob can pay back his civilian loans. Is he going to come out way ahead financially? Probably not, depending on what the interest rate is on his loans, how much money his spouse makes (and therefore how much he pays in taxes), etc. But he isn’t taking a major loss.

In the Air Force, ENT is extremely competitive. There are 4 spots per year, with 8-16 applicants competing for those spots. That means that, depending on the year, your odds of matching are only 25-50%. Ouch. If you don’t match, you are looking at a transitional year and a flight medicine tour. You may or may not be able to get a military or civilian ENT residency after that. So, as an ENT, you make less money in the military, have to deal with the military hassle factor (moving, deployments, TDY, extra paperwork, PT tests, etc), and may not get to be an ENT after all.

So, HPSP is a decent deal for primary care, especially if you go to a school where you would expect to graduate with more than the average $200k in debt.

On the other hand, if you plan to go into a highly-paid and extremely competitive specialty, you may be at a serious disadvantage if you accept the HPSP scholarship, both financially and in terms of your ability to actually match into a residency in your specialty of choice. Note: The recruiters make a big deal about how the military won’t force you into a residency outside of your specialty of choice. They fail to mention that this means you will either match in your specialty or won’t match at all. Always remember that recruiters are not doctors.

What if you aren’t sure what you want to go into? Well, that makes it a pretty big risk, honestly.

What questions do you have?

*Civilian attending salary numbers taken from various internet salary aggregator sites and medical sites that publish salary information, including salary.com and medscape.com. These numbers represent an average and should not be taken as a representation of what any one individual makes. Military pay numbers are taken from the 2016 military pay charts.